6Objective of furcation Treatment The elimination of the microbial plaque from the exposed surfaces of the root complex.The establishment of an anatomy of the affected surfaces that facilitates proper self- performed plaque control.
7Selection of therapeutic mode Varies with:-The class of furcation defect.-The extent and configuration of bone loss.-Other anatomic factors.
8Therapeutic classes of furcation defects Class I: Early defectsClass II:a) Shallow horizontal involvementb) Isolated deep class II furcationsClass II to IV: Advanced defects
9Scaling and root planing In most situations, it results in the resolution of the inflammatory lesion in the gingiva.Most effective in grade I and shallow grade II.Deeper sites respond less favorably.
10Antimicrobials Adjunct to scaling and root planning Chlorhexidine Tetracycline fibersNo clinically significant difference in clinical parameters after irrigation
11Open Debridement Greater calculus removal than closed Ultrasonic Narrow furcationsDome of furcationSurgical access and increased operator experience significantly enhance calculus removal in molar furcation.
13Osseous Surgery Most effective in grade II furcation Osteoplasty and ostectomy techniquesRemove the lip of defect to reduce horizontal depthBone ramps into the furcation to enhance plaque controlReduce probing depths
14Root Resection Indications Teeth serving as abutments Teeth with furcation defect treated successfully with endodontic procedurePatient considerationsGrade II or Grade III
15Root Resection Contraindications Inadequate bone support Fused roots Inoperable endodonticallyPatient considerationsGrade II or grade III
16Sequence of treatment at RSR Endodontic treatmentProvisional restorationRSRPeriodontal surgeryFinal prosthetic restoration
17Which root to remove Remove the root- That will eliminate the furcation and allow maintenance.With the greatest amount of bone and attachment loss.That will eliminate periodontal problem on adjacent teethWith the greatest number of anatomic problemThat least complicate future periodontal maintenance.
18Hemisection Mandibular molars Grade III furcation Need widely separated roots
20Tunnel Preparation Grade III furcation Permits plaque removal Root caries (4% stannous fluoride)25% failure rate at 5 yearsRecurrent periodontitis
21Root SeparationRoot separation involves the sectioning of the root complex and the maintenance of all roots
22Regeneration of Furcation Defects Guided tissue regenerationPredictable outcome of GTR therapy was demonstrated only in grade II furcation involved mandibular molarsless favorable results have been reported in other types of furcation defectsGTR could be considered in areas with isolated degree II furcation defects
23Furcation Defects Mesial or Distal Maxillary Class II Furcations Most predictable Mandibular or Buccal Maxillary Class II FurcationsMesial or Distal Maxillary Class II FurcationsClass III FurcationsLeast predictable
25Osseous Grafting Autogenous bone Allografts Freeze dried bone Demineralized Freeze dried boneAlloplastsHydroxyapatiteNon-porousPorousBioglass
26ExtractionAttachment loss is so extensive that no root can be maintainedIf tooth/gingival anatomy will not allow proper plaque controlFor endodontic or restorative reasonOsseointegrated implant substitute
27PrognosisPrevious concept: Significant furcation involvement means a hopeless long-term prognosis.Recent trends: Simple periodontal therapy is sufficient to maintain long term prognosis unless development of caries in furcation area.
28Prognosis Key to long term success: Thorough diagnosis Selection of patients with good oral hygieneCareful surgical and restorative management
29Patients Factors Determine patient`s goals and expectations Screen for local, behavioral and systemic factors;Oral hygieneComplianceStressIntraoral AccessibilityUncontrolled DiabetesSmokingHealing response to Previous Therapy
30MCQs on Furcation management 1.The treatment of choice in grade II furcation involvement is/area) Nonsurgical periodontal therapyb) Flap procedurec) Odontoplasty and osteoplastyd) Both (b) and (c)
31MCQs on Furcation management 2. Osseous surgery is most effective inA) Grade I furcationB) Grade II furcationC) Grade III furcationD) None
32MCQs on Furcation management 3.Which of the following is a major contraindication to resection of root in furcation management ?a) Inadequate bone supportb) Inoperable endodonticallyc) Poor oral hygiened) None of the above
33MCQs on Furcation management 4.Hemisection can be done inA) Mandibular molarsB) Grade III furcationsC) In widely separated rootsD) All
34MCQs on Furcation management 5. Recent trend for the prognosis of furcation defect isA) Significant furcation involvement means a hopeless long-term prognosis.B) Simple periodontal therapy is sufficient to maintain long term prognosis.C) Simple periodontal therapy is sufficient to maintain long term prognosis unless development of caries in furcation area.D) None